Tailoring immunisation programs in Lismore, New South Wales - we want our children to be healthy and grow well, and immunisation really helps

Introduction: In 2018 in the Australian town of Lismore, New South Wales, 175 children were overdue for scheduled vaccinations, 11% of them being Aboriginal and/or Torres Strait Islander (2018). This study aimed to gain a deeper understanding of the reasons for low coverage. Methods: Aboriginal and non-Aboriginal parents, carers and health service providers were invited to take part in semistructured interviews and focus groups. Open-ended questions were asked about immunisation barriers and enablers, and what strategies may be effective in improving coverage in Lismore. Results: A total of 35 participants took part. Six themes were developed: childhood immunisation in Lismore is limited by access barriers to health services, some families may need additional support to access vaccination services, health services need to ensure that Aboriginal families feel safe and comfortable when accessing their service, parents and carers value reminders and recalls to keep their children's vaccinations up to date, parents' and carers' views influence their decisions to immunise their children, and reliable information about immunisation needs to be available in ways that are meaningful and appropriate for parents and carers. Conclusion: Access barriers and vaccine hesitancy have been contributing to children falling behind in their scheduled vaccinations in Lismore. More flexible health services, culturally safe and appropriate care and more practical support can help overcome structural barriers to health services. Tailored health messages for both Aboriginal and non-Aboriginal parents and carers can assist parents in making wise immunisation choices. More consistent analysis and reporting of routinely available data can identify pockets of low coverage. Publicly funded health services and Aboriginal Community Controlled Health Services are well placed to provide flexible vaccination services for those families who may struggle with access barriers.